100+ Free NLN NACE Adult Health Practice Questions

The NLN NACE (Nursing Acceleration Challenge Exam) — Care of the Adult Client is a 200-item, 4-hour subject specialty exam administered by the National League for Nursing. Nursing programs use it to grant advanced placement or credit-by-exam for adult medical-surgical nursing in LPN-to-RN, RN-to-BSN, and second-degree pathways. Items follow the nursing process and the four NCLEX client-needs categories.

The passing score is set by each individual nursing program, not by NLN. A 75% scaled score is commonly recommended, but programs may set a more stringent benchmark (some require 80% or higher). NLN reports a criterion-referenced scaled score; check your program's NACE policy for the exact cut score and what it covers.

NLN charges $70 for on-site administration and $80 for remote (online proctored) administration. Some testing institutions add a facility fee of $20-$25. Scores are typically available within 24 hours and remain valid for 3 years.

Per the NLN NACE Series Technical Manual (Spring 2021), the Care of the Adult Client exam covers four NCLEX-aligned domains: Safe & Effective Care Environment, Health Promotion & Maintenance, Psychosocial Integrity, and Physiological Integrity. Topics include metabolic regulation, transitions of care, chronic disease management, neurological disorders, cardiac and vascular conditions, GI, GU, integumentary, autoimmune disorders, and blood dyscrasias.

The NCLEX-RN is the licensure exam graduates must pass to practice as registered nurses; it uses computerized adaptive testing. The NACE is a subject-specialty challenge exam used by nursing programs for advanced placement or credit-by-exam — passing it does not grant a license. NACE items are linear (200 items) and aligned to the same four client-needs categories used in the NCLEX test plan.

Focus on adult medical-surgical content: cardiac, respiratory, GI, GU, neurological, and endocrine disorders, plus pharmacology, fluids and electrolytes, and care of the older adult. Use a 4-6 week study plan, take timed full-length practice exams that mirror the 200-item / 4-hour format, and review high-yield topics including diabetes, heart failure, COPD, stroke, and post-op care. Apply the nursing process (assessment, analysis, planning, implementation, evaluation) to every item.

NACE exams are administered through participating nursing programs and approved test sites — both on-site at a campus testing center and remotely via online proctored delivery. You cannot register directly with NLN as an individual; your nursing program enrolls you and confirms the testing modality. Scores are released to you and your institution within about 24 hours.

NACE score reports are valid for 3 years from the exam date per NLN's testing policy. NLN recommends retesting no more often than every six months if a candidate does not achieve their program's required scaled score. Programs may set their own validity period for credit-by-exam decisions.